中重度阻塞性睡眠呼吸暂停低通气综合征合并高血压与认知功能障碍的相关性研究

Correlation between moderate-to-severe obstructive sleep apnea-hypopnea syndrome with hypertension and cognitive impairment

摘要

目的 研究中重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)合并高血压对认知功能障碍的影响，探寻相关影响因素。方法 收集并纳入中重度OSAHS患者(n=30)、合并高血压的中重度OSAHS患者(n=33)和原发性高血压患者(n=37)的一般资料、呼吸暂停指数(apnea hypopnea index, AHI)、最低氧饱和度(lowest oxygen saturation, LSaO₂)等临床资料，使用蒙特利尔认知评估量表(montreal cognitive assessment, MoCA)评估认知功能，并通过头颅磁共振成像(magnetic resonance imaging, MRI)中的改良Fazekas分级评估脑白质病变程度，研究三组患者的认知功能及其影响因素。结果 OSAHS合并高血压组的MoCA评分低于单纯OSAHS组和高血压组，差异有统计学意义(P<0.001)，且OSAHS合并高血压组Fazekas分级异常所占比高于单纯OSAHS组和高血压组，差异有统计学意义(P<0.001)。相关性分析显示，MoCA评分与Fazekas分级呈负相关，差异有统计学意义(P<0.001)，与最低氧饱和度呈正相关(P<0.001)。Logistic回归分析表明，OSAHS合并高血压组与MoCA评分异常(MoCA: OR=13.049，P<0.001)和Fazekas分级异常相关，差异有统计学意义(OR=8.311，P=0.003)。结论 中重度OSAHS合并高血压患者，其认知功能障碍风险升高，脑白质病变是其重要病理基础。

Abstract

Objective To investigate the effects of moderate-to-severe obstructive sleep apnea hypopnea syndrome (OSAHS) with comorbid hypertension on cognitive impairment and explore associated factors. Methods The participants were stratified into three cohorts: moderate-to-severe OSAHS (n=30), moderate-to-severe OSAHS with comorbid hypertension (n=33), and primary hypertension (n=37), with systematic collection of demographic and clinical parameters including apnea hypopnea index (AHI), and lowest oxygen saturation (LSaO₂). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and cerebral white matter lesions were evaluated by modified Fazekas grading on magnetic resonance imaging (MRI). Comparative analyses evaluated cognitive impairment and its influencing factors across three groups. Results The OSAHS-with-hypertension group exhibited significantly lower MoCA scores compared to the OSAHS-alone and hypertension-alone groups (P<0.001). Abnormal Fazekas grades were more prevalent in the OSAHS-with-hypertension group (P<0.001). Correlation analysis revealed a strong negative association between MoCA scores and Fazekas grades (P<0.001) and a positive correlation with lowest oxygen saturation (P<0.001). Logistic regression analysis indicated that the OSAHS-with-hypertension group was significantly associated with abnormalities in MoCA scores (OR=13.049, P<0.001) and Fazekas grading (OR=8.311, P=0.003). Conclusion Patients with moderate-to-severe OSAHS and hypertension exhibit an elevated risk of cognitive impairment, for which cerebral white matter lesions serve as a critical underlying pathology.

关键词

阻塞性睡眠呼吸暂停低通气综合征 / 高血压 / 认知功能 / 蒙特利尔认知评估量表 / 脑白质病变

Key words

Obstructive sleep apnea hypopnea syndrome / Hypertension / Cognitive function / Montreal cognitive assessment / White matter lesions

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